Director, Compliance

Role overview

Zyter is seeking an experienced Director of Compliance to lead compliance oversight across government and commercial healthcare lines of business.

This role serves as Zyter's senior compliance leader, ensuring regulatory adherence across Utilization Management (UM), Care Management (CM), and Disease Management (DM) operations, particularly those supporting Medicare Advantage, Medicaid, and delegated entity arrangements, while maintaining compliance across commercial programs.

Key responsibilities

• Develop, implement, and oversee Zyter's corporate compliance framework for UM, CM, and DM services across government and commercial programs.
• Ensure adherence to state and federal regulatory requirements, including utilization review (UR) filings, third-party administrator (TPA) licensing, HEDIS and quality improvement (QI) standards, CMS regulations, NCQA and URAC accreditation, and other compliance mandates related to utilization review and case management.
• Lead regulatory submissions and audits, including state UR filings, CMS readiness reviews, corrective action plans, and delegation oversight.
• Serve as Zyter's compliance liaison for government and commercial contracts, ensuring timely and accurate reporting, incident management, and adherence to turnaround-time standards.
• Partner with Product, Clinical, and Client Success teams to align operational processes with applicable state and CMS requirements.
• Monitor evolving federal and state legislation affecting Zyter's clients and proactively guide updates to policies, procedures, and training.
• Oversee internal auditing, monitoring, and compliance training programs, maintaining documentation in accordance with CMS and accreditation requirements.
• Serve as a consultant for external client compliance needs, supporting client compliance resources and providing guidance on project decisions.

Required qualifications

• 5–10 years of progressive compliance leadership experience in healthcare, with a focus on managed care, utilization management, care management operations, or payer/TPA environments.
• Strong familiarity with Medicare Advantage, Medicaid, and commercial delegated compliance programs.
• Experience managing state UR filings, quality improvement programs, HEDIS reporting, and CMS compliance audits.
• Deep understanding of turnaround-time regulations, delegation oversight, and accreditation standards, including URAC and NCQA.
• Bachelor's degree or a minimum of 10 years of relevant experience.
• Proven ability to collaborate across departments and influence senior leadership.

Preferred qualifications

• Registered Nurse (RN) licensure.
• Experience leading compliance for a delegated entity or TPA performing utilization management for state or federal programs.
• Knowledge of CMS pilot or demonstration programs, including WISeR and value-based initiatives.

About Zyter

Zyter is a healthcare technology company focused on helping healthcare organizations improve operational efficiency, coordinate complex workflows, and deliver better outcomes through digital platforms, AI orchestration, and clinical services.

Our technology connects data, systems, people, and AI-enabled workflows to support healthcare operations, improve decision-making, and enable more coordinated execution.

Why join Zyter?

• Transforming healthcare: Help redesign healthcare workflows and advance AI-enabled operations across utilization management, care management, and prior authorization.
• Focus on outcomes: Contribute to solutions that improve operational efficiency, reduce manual effort, and support measurable performance improvements.
• Opportunity to make an impact: Work with cross-functional teams to solve complex healthcare challenges and support solutions used by healthcare organizations.
• Collaboration and innovation: Partner with leadership, clinicians, product teams, and technology experts to help shape the future of healthcare operations.